Doctors' Anti-Fat Biases

People who are overweight have a hard time finding physicians who aren't biased against them.

Overweight and obese patients are more likely to switch doctors than their lower weight counterparts are. They're also more likely to end up in the emergency room for conditions that do not require hospitalization and encounter subtle and not-so-subtle biases from the medical professions who treat them, according to two new studies.

A study from Johns Hopkins finds that doctor shopping is far more common among the overweight and obese than among those of normal weight. It defined doctor shopping as seeing three or more different primary care physicians during a two-year period.

From blood pressure cuffs that don't fit and tables that aren't strong enough to off-putting comments from staff and unsolicited weight loss advice, overweight patients have a host of reasons to want to switch.

The decision to change doctors is most often the result of dissatisfaction with one's PCP. It's not a bad thing if you end up with a doctor that meets your needs. But the overweight often don't find a doctor they can connect with and are driven to continue searching. And because they don't remain with their doctor for very long, they are ending up in the emergency room, likely for problems that could have been taken care of in a doctor's office.

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The study looked at over 20,000 Blue Cross/Blue Shield patients. Overall, 23% of the patients engaged in doctor shopping. The percentage for overweight patients was 42% and was 60% for obese patients. It also found that overweight and obese doctor shoppers were 85% more likely to visit the ER than normal-weight non-doctor shoppers. They were also much more likely to visit the ER than overweight an obese people that did not doctor-shop. But they were no more likely to be hospitalized.

An Anti-Fat Bias

The researchers suspect that these numbers reflect the negative experiences overweight people have with the health care system, some of which stem from an anti-fat bias. From blood pressure cuffs that don't fit and tables that aren't strong enough to off-putting comments from staff and unsolicited weight loss advice, overweight patients have a host of reasons to want to switch.

There's plenty of evidence that this isn't just in the heads of overweight patients. And it's likely to continue. A just-published study from Wake Forest School of Medicine on third-year medical students found that about 40% of them — two out of five — had a moderate to strong anti-fat bias. And two-thirds of them weren't even aware of it. Women medical students were considerably less likely to have a conscious anti-fat bias than men, though they were just as likely to have an unconscious bias.

The first step in fighting prejudice is acknowledging that it exists.

Though it's rarely spoken of, obese people are frequent targets of inappropriate humor and discrimination. Americans often associate obese individuals with negative attributes like laziness. Many studies have shown that doctors share this bias. In one study, over half of primary care physicians reported viewing obese individuals as “awkward, unattractive, ugly, and noncompliant with therapy.” Even doctors who specialize in treating obese patients have been shown to have unconscious anti-obesity attitudes.

The Johns Hopkins study on doctor shopping was published online by Obesity and will also appear in a future issue of the journal.

The Wake Forest study on anti-obesity bias was published online ahead of print in Academic Medicine and will also appear in a future print edition of the journal. The study is freely available as a PDF.